The facts

If you have type 2 diabetes, your chance of heart attack or stroke is higher than it is for most other people. In fact, you have the same risk as someone who already has heart disease! So take steps to reduce your risk.

To get your diabetes in control, work with your healthcare provider to get on a program that includes a healthy diet and physical activity. These changes will also help reduce your risk of heart disease and stroke.

Another step may be to use aspirin. Aspirin also helps prevent heart attacks and strokes.

All about aspirin

Most heart attacks and strokes occur when the blood supply to a part of your heart muscle or brain is blocked. This usually starts with atherosclerosis, a process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.

Plaque usually affects large and medium-sized arteries. Plaques can grow large enough to significantly reduce the blood's flow through an artery. But most of the damage occurs when a plaque becomes fragile and ruptures. Plaques that rupture cause blood clots to form that can block blood flow or break off and travel to another part of the body. This is called an embolism.

• If a blood clot blocks a blood vessel that feeds the heart, it causes a heart attack.
• If a blood clot blocks a blood vessel that feeds the brain, it causes a stroke.

Aspirin “thins” the blood and helps prevent blood clots from forming. So it helps prevent heart attack and stroke.

Who should take aspirin?

Healthcare providers suggest aspirin usage for people who have had a previous stroke or heart attack. Recent studies show that aspirin also helps prevent heart attack and stroke in those people who are at high risk for cardiovascular disease — like those with diabetes. Aspirin is recommended for:

• People with type 2 diabetes who also have a history of
  • Myocardial infarction — This is another name for a heart attack.
  • Bypass surgery — This surgery uses a graft artery to create a detour around a diseased artery. 
  • Angina — Angina is chest pain or discomfort that occurs when your heart doesn’t get as much blood and oxygen as it needs. 
  • Transient ischemic attack (TIA) — A TIA is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but usually produces no lasting damage.
  • Peripheral artery disease (PAD) — PAD is the term for atherosclerosis (plaque buildup) in the arteries outside the heart and brain, such as in the legs.
• People with type 2 diabetes also may have other risk factors such as:
  • Increased age (above 40)
  • Family history of cardiovascular disease
  • High blood pressure
  • Smoking
  • High cholesterol levels, specifically high LDL levels

The best way to know if you’re a candidate for aspirin therapy is to ask your healthcare provider. You should not start aspirin on your own.

Baby aspirin or full aspirin?

Most of the dosages in clinical trials have ranged from 81 mg to 325 mg. The American Heart Association generally recommends doses of 75–162 mg per day (or about a baby aspirin to half of an adult aspirin). This dose works as well as higher doses. A lower dosage is better because higher doses tend to result in more side effects and risks.

Know the risks

Because aspirin thins the blood, it can cause several complications. Talk to your doctor if any of these situations apply to you. You should not take aspirin if you:

• Have an aspirin allergy or intolerance
• Are at risk for gastrointestinal bleeding or hemorrhagic stroke
• Drink alcohol regularly
• Are undergoing any simple medical or dental procedures

Using aspirin during a heart attack or stroke

The most important thing to do if any heart attack warning signs occur is to call 9-1-1 immediately. Don't do anything before calling 9-1-1. In particular, don't take an aspirin, then wait for it to relieve your pain. Aspirin won't treat a heart attack by itself.

After you call 9-1-1, the operator may tell you to take an aspirin. He or she can make sure that you don't have an allergy to aspirin or a condition that makes using it too risky. If the 9-1-1 operator doesn't talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it's right for you. Research shows that taking aspirin early in treating a heart attack can significantly improve your chances of survival (along with other treatments).

Don’t take aspirin during a stroke, because not all strokes are caused by blood clots. Some are caused by ruptured blood vessels. Taking aspirin could make these bleeding strokes more severe.

This content is reviewed regularly. Last updated 08/15/08.